When Patients Ask About Barefoot Running And Minimalist Shoes

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Author(s): 
Moderator: Jenny Sanders, DPM Panelists: Richard Blake, DPM, Bill Johncock, DPM, Kevin Kirby, DPM, Doug Richie Jr., DPM, FACFAS, and Nicholas Romansky, DPM, FACFAS

   While Dr. Blake says he has no basis with which to judge if there has been an increase of injuries with the recent barefoot running/minimalist shoe movement, the injuries he has seen have been a combination of minimalist shoes not providing good support or protection, and the athletes being careless about their training regimen with these shoes. For example, Dr. Blake cites an elite runner who switched to minimalist shoes and broke her heel bone, but notes that she also did not change her technique. He says another runner in Vibram Five Fingers stepped up onto a curb and developed severe turf toe in the second toe. “(This) would not have happened in normal shoes,” notes Dr. Blake.

   Dr. Richie says the biggest problem he has seen with the barefoot/minimalist shoe movement is the use of “flimsy lightweight shoes” by overweight, untrained athletes who are taking fitness classes such as Cross Fit and Zumba, or who are exercising at home to videos such as Insanity Workout or P90X.

   “This trend has sent a large number of patients to my office with stress fractures, Achilles tendinopathy and plantar heel pain in numbers like I have never seen in 32 years of running a sports medicine practice,” notes Dr. Richie.

   Dr. Richie says many novice athletes have good intentions when starting a fitness program but they can be swayed when going to an athletic shoe store or department store. Given that minimalist shoes are softer and lighter with the initial fitting in comparison to standard shoes, minimalist shoes are an easy sell for the shoe salesman, notes Dr. Richie.

   “The victim is the unsuspecting future patient who succumbs to the cool look and ultra lightweight feel of the minimalist shoe,” says Dr. Richie.

   Describing himself as a 170-pound moderate overpronator who had typically worn stability shoes with custom orthotics, Dr. Johncock attempted his own “study of one” two years ago with a six-month transition to less supportive shoes and ceasing to use his orthotics. He wound up with an Achilles injury. He is 48 years old, has been running for 35 years and has a past history of Achilles injuries. However, as a result of his “experiment,” Dr. Johncock has moved into a more “neutral shoe” and wears lighter weight shoes for his speedwork and races just as he did during his younger days. Dr. Johncock notes that he returned to wearing his orthotics.

   “I did not feel the risk of total transition to minimalist shoes was worth the potential benefit for me,” notes Dr. Johncock. “If I wake with knee pain tomorrow, I may change my mind.”

Q:

Are you seeing more runners or fewer runners interested in barefoot running?

A:

The majority of the panelists say patient interest in barefoot running has significantly declined. Dr. Johncock still has a number of patients asking about barefoot running but notes that it has “tapered off from the exponential increase of one to two years ago.”

   “Most runners are starting to realize that the poorly designed research studies that come from those who received monetary compensation from minimalist shoe companies were biased toward selling more five-toed shoes and not toward allowing runners to train more, run faster and have fewer injuries,” asserts Dr. Kirby.

   However, Drs. Sanders, Richie and Blake are still seeing curiosity and interest in minimalist shoes. Dr. Sanders says the new questions from runner patients tend to be on minimalist shoes versus structured running shoes and ascertaining the ideal, heel-to-toe differential. When it comes to his runner patients, Dr. Richie says there is growing interest in trying minimalist shoes and changing their foot strike pattern in running in the hopes of improving their performance.

   “This trend is definitely growing and so is my practice,” claims Dr. Richie.

   “Runners will always want to try to reduce injury and improve performance. Podiatrists will always be part of this conversation. This is a good thing,” asserts Dr. Sanders.

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Brian Fullem, DPMsays: May 6, 2013 at 2:25 pm

Excellent discussion with many salient points. I have seen a lot of minimalist and even a few true barefoot runners here in Tampa. I think the injury rate is similar to those runners in traditional shoes but different areas - cuboid, sesamoid and metatarsal stress fractures are the most common. I have noted in the last 6 months a decrease in those using Vibrams or other similar shoes and an increase in the use of shoes such as the Brook Pure series or New Balance Minimus, which as Dr Kirby correctly pointed out are not much different from the road racing shoes of the 1960s-1980s.

Brian W. Fullem, DPM
Tampa, FL

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Kevin A. Kirby DPMsays: May 20, 2013 at 11:30 am

Brian:

Thanks for your comments.

As an older runner with 40 years of distance running under my belt, probably one of the most bizarre things I have seen in this "barefoot-minimalist shoe fad" is the claim by the barefoot-minimalist shoe advocates that they have somehow created a new shoe: the minimalist running shoe.

During my high school and college years of competing in cross-country, track and road races from 1972-1979, myself and many other runners in Northern California often wore racing flats that were thinner soled and lower heeled than today's "minimalist shoes." This was over three decades before the barefoot crowd proclaimed that they had invented a new type of running shoe ... the minimalist shoe. Amazing!

I am all for more running shoe selection for the public but I just hope we can put down this nonsense that minimalist shoes are anything more than a return to racing flats for training ... something which many of us were regularly doing back in the 1970s!

Nothing new under the sun.

Cheers,

Kevin A. Kirby, DPM

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Patrick Johnsonsays: June 14, 2013 at 6:27 am

Most advocates of barefoot running are advocating a change in form as much as they are advocating throwing away the shoe. One basic characteristic of this form is that the foot strikes the ground under the body rather than in front. It is difficult to strike under the body with the heel, thus the change to the midfoot or forefoot strike. The biomechanical evidence supporting this form and foot strike is very compelling. This way of coming down with the foot eliminates a sharp impact peak that is present with the heel strike in front of the body.

If you run barefoot, you feel this impact peak more so you naturally change your form to avoid it. Alternatively, you can learn this way of running with a regular shoe and practice.

Then there is the second very interesting discussion about the anthropological history of running barefoot (I.e. were we meant to wear shoes with big heels?).

These are logical arguments from both a scientific and common sense perspective, and should be taken seriously.

Of course, if you are changing your form and your shoes, you need to build up slowly. Most people have very little sense of what building up slowly means. I personally switched to minimalist shoe running over a period of two years starting with short 2-5 minute runs during my lunch break. My calves and Achillies were often sore at the start and needed to be built up. I wouldn't recommend any other approach. My motivation was that I could not previously run due to knee injuries.

Running barefoot and/or minimalist shoes are not new ideas. That is the point. Often an old idea gains popularity for new reasons. The new reasons are those mentioned above.

I find the whole discussion extremely interesting and more than just a fad. This is a debate that has engaged elite runners, Harvard scientists, anthropologists, as well as bloggers and everyday joggers.

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